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Clinical spectrum of COVID-19 and risk factors associated with severity in Spanish children.
Tagarro, Alfredo; Cobos-Carrascosa, Elena; Villaverde, Serena; Sanz-Santaeufemia, Francisco-Javier; Grasa, Carlos; Soriano-Arandes, Antoni; Hernanz, Alicia; Navarro, María Luisa; Pino, Rosa; Epalza, Cristina; Batista, Rosa; Rizo, Jana; Iglesias-Bouzas, María-Isabel; Rodríguez-Molino, Paula; Villanueva-Medina, Sara; Carrasco-Colom, Jaime; Alonso-Cadenas, José-Antonio; Mellado, María-José; Herrero, Blanca; Melendo, Susana; De La Torre, Mercedes; Calleja, Lourdes; Calvo, Cristina; Urretavizcaya-Martínez, María; Astigarraga, Itziar; Menasalvas, Ana; Penin, María; Neth, Olaf; Berzosa, Arantxa; De Ceano-Vivas, María; Vidal, Paula; Romero, Isabel; González, Raúl; García, María Luz; Mesa, Juan-Miguel; Ballesteros, Álvaro; Bernardino, María; Moraleda, Cinta.
  • Tagarro A; Paediatrics Department, Paediatrics Research Group, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, Madrid, Spain. alfredotagarro@gmail.com.
  • Cobos-Carrascosa E; Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), RITIP (Translational Research Network in Paediatric Infectious Diseases), Madrid, Spain. alfredotagarro@gmail.com.
  • Villaverde S; Pediatrics Department, Hospital Universitario Infanta Sofía, Madrid, Spain. alfredotagarro@gmail.com.
  • Sanz-Santaeufemia FJ; Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), RITIP (Translational Research Network in Paediatric Infectious Diseases), Madrid, Spain.
  • Grasa C; Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), RITIP (Translational Research Network in Paediatric Infectious Diseases), Madrid, Spain.
  • Soriano-Arandes A; Paediatrics Department, Hospital Universitario Niño Jesús, Madrid, Spain.
  • Hernanz A; Paediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, RITIP (Translational Research Network in Paediatric Infectious Diseases), Instituto Investigación Hospital La Paz (IDIPaz), Madrid, Spain.
  • Navarro ML; Infectious Diseases and Paediatric Immunology Unit, Department of Paediatrics, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
  • Pino R; Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario Gregorio Marañón, Madrid, Spain.
  • Epalza C; Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario Gregorio Marañón, Madrid, Spain.
  • Batista R; Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario Sant Joan de Deu Barcelona, Barcelona, Spain.
  • Rizo J; Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), RITIP (Translational Research Network in Paediatric Infectious Diseases), Madrid, Spain.
  • Iglesias-Bouzas MI; Paediatric Infectious Diseases Unit, Department of Paediatrics, Paediatric Research and Clinical Trials Unit (UPIC), Hospital Universitario 12 de Octubre, Madrid, Spain.
  • Rodríguez-Molino P; Paediatrics Department, Paediatrics Research Group, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, Madrid, Spain.
  • Villanueva-Medina S; Paediatrics Department, Paediatrics Research Group, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, Madrid, Spain.
  • Carrasco-Colom J; Paediatric Intensive Care Unit, Hospital Universitario Niño Jesús, Madrid, Spain.
  • Alonso-Cadenas JA; Paediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, RITIP (Translational Research Network in Paediatric Infectious Diseases), Instituto Investigación Hospital La Paz (IDIPaz), Madrid, Spain.
  • Mellado MJ; Paediatric Infectious Diseases Unit, Department of Paediatrics, Paediatric Research and Clinical Trials Unit (UPIC), Hospital Universitario 12 de Octubre, Madrid, Spain.
  • Herrero B; Paediatric Infectious Diseases Unit, Department of Paediatrics, Paediatric Research and Clinical Trials Unit (UPIC), Hospital Universitario 12 de Octubre, Madrid, Spain.
  • Melendo S; Paediatrics Department, Hospital Universitario Niño Jesús, Madrid, Spain.
  • De La Torre M; Paediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, RITIP (Translational Research Network in Paediatric Infectious Diseases), Instituto Investigación Hospital La Paz (IDIPaz), Madrid, Spain.
  • Calleja L; Paediatrics Department, Hospital Universitario Niño Jesús, Madrid, Spain.
  • Calvo C; Infectious Diseases and Paediatric Immunology Unit, Department of Paediatrics, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
  • Urretavizcaya-Martínez M; Paediatrics Department, Hospital Universitario Niño Jesús, Madrid, Spain.
  • Astigarraga I; Paediatrics Department, Hospital Universitario Niño Jesús, Madrid, Spain.
  • Menasalvas A; Paediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, RITIP (Translational Research Network in Paediatric Infectious Diseases), Instituto Investigación Hospital La Paz (IDIPaz), Madrid, Spain.
  • Penin M; Paediatrics Department, Complejo Hospitalario de Navarra, Pamplona, Spain.
  • Neth O; Department of Pediatrics, Hospital Universitario Cruces, Biocruces Bizkaia Health Research Institute, University of the Basque Country UPV/EHU, OsakidetzaBarakaldo, Spain.
  • Berzosa A; Paediatrics Department, Hospital Universitario Virgen de La Arrixaca, Murcia, Spain.
  • De Ceano-Vivas M; Paediatrics Department, Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, Spain.
  • Vidal P; Paediatrics Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
  • Romero I; Paediatrics Department, Hospital Universitario Clínico San Carlos, Madrid, Spain.
  • González R; Emergency Pediatrics Department, Hospital Universitario La Paz, Instituto Investigación Hospital La Paz (IDIPaz), Madrid, Spain.
  • García ML; Paediatrics Department, Hospital Universitario Lozano Blesa, Zaragoza, Spain.
  • Mesa JM; Paediatrics Department, Hospitales HM, Madrid, Spain.
  • Ballesteros Á; Paediatrics Department, Hospital Universitario Sant Joan, Comunidad Valenciana, AlacantAlicante, Spain.
  • Bernardino M; Paediatrics Department, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain.
  • Moraleda C; Paediatrics Department, Paediatrics Research Group, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, Madrid, Spain.
Eur J Pediatr ; 2021 Nov 05.
Article in English | MEDLINE | ID: covidwho-1504861
ABSTRACT
We aimed to identify the spectrum of disease in children with COVID-19, and the risk factors for admission in paediatric intensive care units (PICUs). We conducted a multicentre, prospective study of children with SARS-CoV-2 infection in 76 Spanish hospitals. We included children with COVID-19 or multi-inflammatory syndrome (MIS-C) younger than 18 years old, attended during the first year of the pandemic. We enrolled 1200 children. A total of 666 (55.5%) were hospitalised, and 123 (18.4%) required admission to PICU. Most frequent major clinical syndromes in the cohort were mild syndrome (including upper respiratory tract infection and flu-like syndrome, skin or mucosae problems and asymptomatic), 44.8%; bronchopulmonary syndrome (including pneumonia, bronchitis and asthma flare), 18.5%; fever without a source, 16.2%; MIS-C, 10.6%; and gastrointestinal syndrome, 10%. In hospitalised children, the proportions were 28.5%, 25.7%, 16.5%, 19.1% and 10.2%, respectively. Risk factors associated with PICU admission were age in months (OR 1.007; 95% CI 1.004 to 1.01), MIS-C (OR 14.4, 95% CI 8.9 to 23.8), chronic cardiac disease (OR 4.8, 95% CI 1.8 to 13), asthma or recurrent wheezing (OR 2.5, 95% CI 1.2 to 5.2) and after excluding MIS-C patients, moderate/severe liver disease (OR 8.6, 95% CI 1.6 to 47.6). However, asthmatic children were admitted into the PICU due to MIS-C or pneumonia, not due to asthma flare.

Conclusion:

Hospitalised children with COVID-19 usually present as one of five major clinical phenotypes of decreasing severity. Risk factors for PICU include MIS-C, elevation of inflammation biomarkers, asthma, moderate or severe liver disease and cardiac disease. What is Known • All studies suggest that children are less susceptible to serious SARS-CoV-2 infection when compared to adults. Most studies describe symptoms at presentation. However, it remains unclear how these symptoms group together into clinically identifiable syndromes and the severity associated with them. What is New • We have gathered the primary diagnoses into five major syndromes of decreasing severity MIS-C, bronchopulmonary syndrome, gastrointestinal syndrome, fever without a source and mild syndrome. Classification of the children in one of the syndromes is unique and helps to assess the risk of critical illness and to define the spectrum of the disease instead of just describing symptoms and signs.
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Full text: Available Collection: International databases Database: MEDLINE Document Type: Article Type of study: Etiology study / Observational study / Prognostic study / Risk factors Language: English Clinical aspect: Etiology Year: 2021

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Full text: Available Collection: International databases Database: MEDLINE Document Type: Article Type of study: Etiology study / Observational study / Prognostic study / Risk factors Language: English Clinical aspect: Etiology Year: 2021
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